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Knee Osteoarthritis

Platelet-Rich Plasma (PRP) Injections for the treatment of knee osteoarthritis

A new study published in the American Journal of Sports Medicine looked at the use of Platelet Rich Plasma (PRP) injections for osteoarthritis of the knee both from a safety and efficacy standpoint.

This was a small study consisting of 30 patients who received an intra-articular PRP injection in the knee consecutively for 3 weeks. Specifically, 3 to 8 mL of PRP was injected. Patients in the control group received 3 intra-articular injections of saline. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used to assess outcome.

The results showed that those who received the PRP injections had a 78% improvement from baseline whereas the controls only had a 7% improvement at 12 months. WOMAC scores improved to a greater degree in the PRP group than controls starting at 2 weeks. This effect lasted throughout the duration of the study.

Overall there were no adverse events associated with the PRP injections. As this study was sanctioned by the Food and Drug Administration (FDA), the small study size was mandated to evaluate for safety. The results of this study support prior observations by Duymus et al (Knee Surgery Sports Traumatology Arthroscopy 2016) and Kavadar et al (Journal of Physical Therapy Science 2015). A recent systematic review by Meheux et al (Arthroscopy 2016) which included 6 published studies with a minimum of 6 months of follow-up also reported significant clinical efficacy for PRP injections in the treatment of knee osteoarthritis up to 12 months.

References:

Smith P. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled trial. American Journal of Sports Medicine. 2016. Apr 44(4): 884-891.

Duymus TM et al. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. Apr 7.

Kavadar G. et al. Effectieness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. Journal of Physical Therapy Science. 2015: Dec 27(12): 3863-3867.

Meheux CJ et al. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A systematic review. Arthroscopy. 2016. Mar 32(3): 495-505.

Is Platelet Rich Plasma (PRP) effective for knee osteoarthritis?

Traditional treatment for knee osteoarthritis has been focused on knee strengthening, the use of non-steroidal anti-inflammatory medication (NSAIDs), and corticosteroid injections. Additional non-surgical options including viscosupplementation is also a treatment option for some with mild to moderate joint degeneration and have failed other first line treatment options.

Several studies have been published this year in regards to looking at the efficacy of PRP injections for patients who suffer from knee osteoarthritis.

A meta-analysis published by Campbell et al (May 2015), looked at the use of PRP versus corticosteroid injections, viscosupplementation injections, NSAIDs, and placebo. The findings from the literature searches did show that PRP injections led to significant improvements in pain and function at 6 months and maintained effect until 12 months post-injection. Those with milder findings of osteoarthritis radiographically appeared to have greater benefit from PRP injections.

A more recent double-blinded randomized clinical trial by Forogh et al (July 2015), evaluated one injection of PRP versus an intra-articular corticosteroid injection for symptomatic osteoarthritis of the knee. Patients with grade II/III osteoarthritis were randomly divided into two groups. Outcome measures included the Knee injury and osteoarthritis outcome score (KOOS), 20 meter walk test, knee range of motion, flexion contracture, and Visual Analog Scale (VAS) for pain assessment. Patients treated with one PRP injection had greater relief of pain compared to the corticosteroid group. A greater percentage of those treated with PRP were symptom free following injection, had improved activities of daily living and quality of life scores at follow-up.

In another randomized control trial conducted by Filardo et al (July 2015), researchers looked at the potential benefit of PRP injections compared to hyaluronic acid (viscosupplementation) injections for patients with at least a 4 month history of chronic knee pain and accompanying degenerative changes.

For this study, patients had 3 weekly intra-articular injections of either PRP or hyaluronic acid. Outcome measures included the International Knee Documentation Committee (IKDC) subjective score, KOOS score, EuroQol visual analog scale and Tegner score. The findings of the study revealed that both treatments were effective at improving knee functional status and decreasing pain. No significant differences were identified between PRP and hyaluronic acid.

While these studies do show the potential for PRP to be beneficial for those with knee osteoarthritis, it remains unclear as to how many injections are ideal. Furthermore, the preparation methods of the PRP, and the activating agent must also be considered.